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Multiagency team work is also essential proven 10 mg prozac, working with social care professionals and ensuring seamless communication between general practice and the specialist services involved in the patient’s antenatal care generic prozac 10 mg online, including obstetrics 10mg prozac with visa, specialist drug services and any other specialist healthcare services. Multiagency case conferences, with prospective parents invited as participating attendees, will facilitate good inter-team communication and optimise clinical care. Her family were very strict and she was not allowed to have friends outside the community. Between the ages of 10 and 13 she was subjected to regular sexual abuse by an uncle who lived with the family. She once told her mother about the abuse but was told to keep it quiet and not tell anyone, as it would bring shame on the family. She did well at school and started work in a local estate agent’s office when she left school. Mr Y was a heroin user and eventually she started smoking cigarettes that he gave her. After a few months, she noticed that she felt very unwell if she did not smoke and Mr Y told her that the cigarettes had heroin in them. She had very little antenatal care and avoided the appointments with the social worker, who she only met once. For a few weeks she went back, with her baby, to live with her parents (with the support of social services) and stopped using heroin but the rows with her mother were so bad she eventually left the baby with her mother and went to live with Mr Y in a big city. She came into treatment when Mr Y was arrested for aggravated burglary and went to prison. She was prescribed buprenorphine and managed in an antenatal liaison clinic, where she received antenatal care and drug treatment. Social services were involved from the beginning and found her a place in a local women’s hostel. Ms B was able to stop using heroin and begin to think about some of the problems she had with her abusive relationship and her history of sexual abuse. Her second baby, a little girl, was born at full term and was immediately subject to child protection proceedings and taken into foster care but Ms B had regular contact with the baby. She subsequently went, with the baby, to a mother and baby rehabilitation centre where her parenting could be assessed and she could reduce her buprenorphine. Ms B was clear she wanted to stop using all drugs, keep her daughter and re-establish a relationship with her son and her family. Case study details provided by Dr Emily Finch, a consultant addiction psychiatrist. It is safest to prescribe opiate substitution (see Chapter 8) ‘at a dose that stops or minimises illicit use’. In all pregnant women using or prescribed opioid drugs, particular consideration will also need to be given to their birthing plan, including pain management and the risk of fetal distress at birth. In view of the potential harms to the fetus and to the mother’s health, the pregnant woman should be given support to stop using cocaine during pregnancy. A non-judgemental, sensitive approach, with clear and effective multidisciplinary communication and team working are again essential, addressing the full spectrum of psychosocial and physical health needs. The maximum penalty is life imprisonment for supply of Class A drugs, with seven years for possession, but sentences between two and 14 years are used for possession or supply of Class B or C drugs (see Chapter 1). This has implications for the medical professional, as many illicit drug users first come into contact with the medical profession via the criminal justice system. This can create particular challenges for medical professionals working within the criminal justice setting, which are highlighted throughout this chapter. It offers a valuable opportunity for effective medical treatment of drug use disorder and ultimately the best chance for many dependent drug users to be rehabilitated. A report from the Probation Service explained that she had been picked up by police after having collapsed in the stairwell of a housing estate in east London. It also explained that she was homeless; she had been living in a local authority hostel but had been thrown out of it for taking men back into the hostel for the purpose of prostitution in order to raise funds to feed her drug habit. She was barely conscious at the time that she was found by the police and was high on drugs. She was due to be sentenced for a series of offences, which included attempted robberies of mobile phones from young women whom she had threatened with a knife, and attempts to snatch handbags, also from young women leaving a tube station late at night. The probation report explained that she committed these offences to raise funds to buy drugs and that she was so dependent that, unless she was taken off the streets (and in effect given a lengthy prison sentence), there was a real risk that she would die. The oldest was a six-year-old girl, who had been taken away by the grandmother to Belgium (it was said that she had, in effect, abducted the granddaughter to save her from her mother) and she also had a two-year-old child who was in care. After hearing evidence from the Probation Services, the court imposed a prison sentence at the maximum end of the scale for offences of that nature. The court discussed the possible range of sentences with defence and prosecution counsel and the discussion proceeded upon the basis that it was, in effect, common ground that, for her own good, she needed to be given a custodial sentence of the longest duration that was proper in the circumstances. This would give the defendant the best chance of receiving drug treatment in prison. The case was unusual in that the Probation Service was able to make enquiries about which prison the defendant would be sent to, and about the availability of drug treatment courses in that prison. This was exceptional, since it is very rare indeed for a sentencing judge to know anything about the prison to which a defendant is to be sent, or about the availability of drug rehabilitation courses in that prison. While drug treatment programmes delivered in a controlled prison environment may offer some prisoners the opportunity to be rehabilitated, rates of drug use during incarceration remain high. Analysis of the findings of the 1997 National Survey found that over a quarter of the men who had used heroin reported first initiating use in prison. Care planning is integral to the process; this is an agreed plan of action between the service user and the Criminal Justice Intervention Team worker, which involves setting goals based on the individual needs identified. This plan documents and enables routine review of the service user’s needs, goals and progress across four key domains: • drug and alcohol use • physical and psychosocial health • offending • social functioning (including housing, employment and relationships). The different levels/tiers of treatment reflected their intensity and ranged from non-specialist general healthcare through open drugs treatment and community-based drug treatment to residential drug treatment. This requirement is one of a menu of 12 requirements to which offenders can be sentenced. There are three levels of intensity of contact, which include, but do not entirely consist of, medical treatment. Before making the requirement, the court must be satisfied that: • the offender is dependent on or has a propensity to use any controlled drug • he or she would benefit from treatment • the necessary arrangements can be made for the treatment • the offender agrees to comply with the requirement. Arrangements for treatment are available through the Probation Trusts, which operate at a local level. There is provision for the court to review the progress of the offender during the order, and to agree changes in the treatment. The treatment can be residential or non-residential, which is decided by the court, and must be supervised by a suitably qualified person. A review of the National Drug Rehabilitation Requirement found a variation in treatment delivery across England and Wales. Sessions were set aside in existing magistrates’ courts for dedicated panels of magistrates or particular district judges to sit for sentencing. Appropriate sanctions and other rehabilitation services that could be included in community sentences were available to all courts in England and Wales. In January 2011, the Ministry of Justice published The Dedicated Drug Courts Pilot Evaluation Process Study.

Pharmacodynamics The action of digestants resembles the action of the body sub- stances they replace purchase prozac 10 mg mastercard. Breaking it down These drugs contain trypsin to digest proteins order generic prozac online, amylase to digest carbohydrates buy 10 mg prozac amex, and lipase to digest fats. Pharmacotherapeutics Because their action resembles the action of the body substances they replace, each digestant has its own indication. Mirror images Pancreatic enzymes are administered to the patient with insuffi- cient levels of pancreatic enzymes, such as the patient with pan- creatitis or cystic fibrosis. They may also be used to treat steator- rhea (disorder of fat metabolism characterized by fatty, foul- smelling stool). Drug interactions Antacids reduce the effects of pancreatic enzymes and shouldn’t be given at the same time. Drugs for obesity fall into two categories: • appetite suppressants (phentermine and sibutramine) • fat blockers (orlistat). Pharmacokinetics Sibutramine is rapidly absorbed from the intestines and rapidly distributed to most body tissues. Pharmacodynamics Appetite suppressants increase the amount of norepinephrine and dopamine in the brain, thereby suppressing the appetite. Pharmacotherapeutics Appetite suppressants and fat blockers are used primarily for weight loss when losing weight will improve the patient’s health and prevent death. Adverse reactions to obesity drugs Adverse reactions to obesity drugs include the following: • Phentermine can cause nervousness, dry mouth, constipation, and hypertension. Laxatives stimulate defecation and include: • hyperosmolar drugs • dietary fiber and related bulk-forming substances • emollients • stimulants • lubricants. Diphenoxylate with atropine is metab- Adverse reactions to olized to difenoxin, its biologically active major metabolite. These or distention drugs also decrease expulsive contractions throughout the colon. Diphenoxylate with atropine and loperamide may enhance the de- pressant effects of barbiturates, alcohol, opioids, tranquilizers, and sedatives. Pharmacokinetics Kaolin and pectin aren’t absorbed and, therefore, aren’t distrib- uted throughout the body. Pharmacodynamics Kaolin and pectin act as adsorbents, binding with bacteria, toxins, and other irritants in the intestinal mucosa. Pectin decreases the pH in the intestinal lumen and provides a soothing effect on the ir- ritated mucosa. They may also be used to temporarily relieve chronic diar- rhea until the cause is determined and definitive treatment begun. Adverse Drug interactions reactions to These antidiarrheals can interfere with the absorption of digoxin kaolin and and other drugs by the intestinal mucosa if administered at the pectin same time. This drug is available and with overdose or only through a restricted marketing program because of reported prolonged use. Only prescribers enrolled in the pre- scribing program for alosetron may write a prescription for it. Pharmacokinetics Alosetron is rapidly absorbed after oral administration and is me- Warning! The drug shouldn’t be and complications of taken if the patient is constipated and should be stopped if consti- constipation, including pation develops. Although studies haven’t been done, the inhibition of increased sensitivity to N-acetyltransferase may have clinical significance when alosetron alosetron’s effects, thus is given with such drugs as isoniazid, procainamide, and hydral- increasing their risk of azine. Direct placement Glycerin is placed directly into the colon by enema or suppository and isn’t absorbed systemically. Pharmacodynamics Hyperosmolar laxatives produce a bowel movement by drawing water into the intestine. Fluid accumulation distends the bowel and promotes peristalsis, resulting in a bowel movement. Adverse reactions to hyperosmolar laxatives Adverse reactions to most hyperosmolar laxatives involve fluid and electrolyte imbalances. Glycerin • Hypovolemia • Hyperphosphatemia • Weakness • Increased blood glucose • Hypocalcemia • Fatigue level • Cardiac arrhythmias • Shock Lactulose Saline compounds • Abdominal distention and • Weakness Polyethylene glycol cramps, gas • Lethargy • Nausea • Nausea and vomiting • Dehydration • Explosive diarrhea • Diarrhea • Hypernatremia • Bloating • Hypokalemia • Hypermagnesemia Drug interactions A diet high in Hyperosmolar laxatives don’t interact significantly with other fiber is the best drugs. Bulking up Bulk-forming laxatives, which resemble dietary fiber, contain natural and semisynthetic polysaccharides and cellulose. These laxatives include: • methylcellulose • polycarbophil • psyllium hydrophilic mucilloid. Pharmacokinetics Dietary fiber and bulk-forming laxatives aren’t absorbed systemi- cally. The polysaccharides in these drugs are converted by intesti- nal bacterial flora into osmotically active metabolites that draw water into the intestine. Pharmacodynamics Dietary fiber and bulk-forming laxatives increase stool mass and water content, promoting peristalsis. Drug interactions Decreased absorption of digoxin, warfarin, and salicylates occurs Warning! This detergent action allows water and fats to stool that can’t be re- penetrate stool, making it softer and easier to eliminate. Pharmacokinetics Stimulant laxatives are minimally absorbed and are metabolized in the liver. Pharmacodynamics Stimulant laxatives promote peristalsis and produce a bowel movement by irritating the intestinal mucosa or stimulating nerve endings of the intestinal smooth muscle. Adverse They’re also used to treat constipation caused by prolonged reactions to bed rest, neurologic dysfunction of the colon, and constipating stimulant drugs such as opioids. However, because these laxatives produce increased intesti- clude: nal motility, they reduce the absorption of other oral drugs admin- • weakness istered at the same time, especially sustained-release forms. Pharmacokinetics In its nonemulsified form, mineral oil is minimally absorbed; the emulsified form is about half absorbed. Absorbed mineral oil is distributed to the mesenteric lymph nodes, intestinal mucosa, liv- er, and spleen. Metabolism and excretion Mineral oil is metabolized by the liver and excreted in stool. Pharmacodynamics Mineral oil lubricates stool and the intestinal mucosa and prevents water reabsorption from the bowel lumen. Adverse reactions to mineral oil Adverse reactions to mineral oil include: • nausea and vomiting • diarrhea • abdominal cramping. Mineral oil can impair the Impacting impaction absorption of some oral Administered orally or by enema, this lubricant laxative is also drugs. To minimize drug interactions, adminis- ter mineral oil at least 2 hours before these medications.

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Cefaclor is shown to be active against most strains of the following microorgansims buy cheap prozac 10mg on-line, both in vitro and in clinical infections: Aerobes order line prozac, Gram-Positive: Staphylococci purchase 20mg prozac, including coagulase-positive, coagulase-negative, and penicillinase- producing strains. Note: Pseudomonas sp, Acinetobacter and most strains of enterococci (Enterococcus faecalis), Enterobacter spp, indole-positive Proteus, and Serratia spp are resistant to cefaclor. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents. Several cephalosporins have been implicated in triggering seizures, paticularly in patients with renal impairment when the dosage was not reduced. When organisms are susceptible, Cefazolin sodium is active against the following organisms in vitro and in clinical infections: Staphylococcus aureus (including penicillinase-producing strains). Staphylococcus epidermidis Group A beta-haemolytic streptococci and other strains of streptococci (many strains of enterococci are resistant). Most strains of indole positive Proteus (Proteus vulgaris), Enterobacter cloacae, Morganella morganii and Providencia rettgeri are resistant. Serratia, Pseudomonas, Mima, Herellea species are almost uniformly resistant to cefazolin. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents. Positive direct and indirect antiglobulin (Coombs) tests have occurred; these may also occur in neonates whose mothers received cephalosporins before delivery. Haemopoietic System: Neutropaenia, leukopaenia, thrombocytopaenia, thrombocythaemia, eosinophilia. Skin: Skin rash Gastrointestinal System: Diarrhoea, oral candidiasis (oral thrush), vomiting, nausea, stomach cramps, anorexia and pseudomembranous colitis. Several cephalosporins have been implicated in triggering seizures, paticularly in patients with renal impairment when the dosage was not reduced. For doses not equalling vial size, prepare the solutions as follows: Vial size 500mg 1gm 2gm Volume of diluent 10ml 10ml 10ml Volume of final solution 10. Cefotaxime sodium has a high degree of stability in the presence of beta-lactamases, both penicillinases and cephalosporinases, of gram- negative and gram-positive bacteria. Cefotaxime has been shown to be active against most strains of the following microorganisms both in vitro and in clinical infections: Aerobes, Gram-Positive: Enterococcus spp. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents. Agranulocytosis As with other beta-lactam antibiotics, granulocytopaenia and, more rarely, agranulocytosis may develop during treatment with cefotaxime sodium, particularly if given over long periods. Haematologic System: Neutropaenia, transient leukopaenia, eosinophilia, thrombocytopaenia and agranulocytosis have been reported. Some individuals have developed positive direct Coombs Tests during treatment with cefotaxime sodium and other cephalosporin antibiotics. Kidney: As with some other cephalosporins, interstitial nephritis and transient elevations of creatinine have been occasionally observed with cefotaxime sodium. Cutaneous: As with other cephalosporins, isolated cases of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported. Several cephalosporins have been implicated in triggering seizures, paticularly in patients with renal impairment when the dosage was not reduced. In addition, ceftazidime has been shown to be active against gram-positive organisms (although it is not 1st line for these infections). Ceftazidime has been shown to be active against the following organisms both in vitro and in clinical infections: Gram-Negative Aerobes: Citrobacter spp. Gram-Positive Aerobes: Staphylococcus aureus, including penicillinase- and non-penicillinase-producing strains. Ceftazidime and the aminoglycosides have been shown to be synergistic in vitro against Pseudomonas aeruginosa and the enterobacteriaceae. Ceftazidime is not active in vitro against methicillin-resistant staphylococci, Streptococcus faecalis and many other enterococci, Listeria monocytogenes, Campylobacter spp. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents. High and prolonged serum ceftazidime concentrations can occur from usual dosages in patients with transient or persistent reduction of urinary output because of renal insufficiency. The total daily dosage should be reduced when ceftazidime is administered to patients with renal insufficiency. Elevated levels of ceftazidime in these patients can lead to seizures, encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia. If patients fail to respond to monotherapy, an aminoglycoside or similar agent should be considered. Several cephalosporins have been implicated in triggering seizures, paticularly in patients with renal impairment when the dosage was not reduced. The bactericidal activity of ceftriaxone results from inhibition of cell wall synthesis. Ceftriaxone has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections: Aerobic Gram-Negative Microorganisms: Acinetobacter calcoaceticus Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzae (including ampicillin-resistant and beta-lactamase producing strains) Haemophilus parainfluenzae Klebsiella oxytoca Klebsiella pneumoniae Moraxella catarrhalis (including beta-lactamase producing strains) Morganella morganii Neisseria gonorrhoeae (including penicillinase- and nonpenicillinase-producing strains) Neisseria meningitidis Proteus mirabilis Proteus vulgaris Serratia marcescens Note: Many strains of the above organisms that are multiply resistant to other antibiotics, e. Aerobic Gram-Positive Microorganisms: Staphylococcus aureus (including penicillinase-producing strains) Staphylococcus epidermidis Streptococcus pneumoniae Streptococcus pyogenes Viridans group streptococci Note: Methicillin-resistant staphylococci are resistant to cephalosporins, including ceftriaxone. Anaerobic Microorganisms: Bacteroides fragilis Clostridium species Peptostreptococcus species Note: Most strains of Clostridium difficile are resistant. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents. Several cephalosporins have been implicated in triggering seizures, paticularly in patients with renal impairment when the dosage was not reduced. Inject slowly over 3-5 minutes If dose does not equal vial size, prepare as follows to obtain desired dose: Vial size Volume of diluent Final volume Concentration 750mg 4. The bactericidal action of cefuroxime results from inhibition of cell-wall synthesis. Cefuroxime is usually active against the following organisms in vitro: Aerobes, Gram-Positive: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, and Streptococcus pyogenes (and other streptococci). Methicillin-resistant staphylococci and Listeria monocytogenes are resistant to cefuroxime. Anaerobes: Gram-positive and gram-negative cocci (including Peptococcus and Peptostreptococcus spp. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents. Several cephalosporins have been implicated in triggering seizures, paticularly in patients with renal impairment when the dosage was not reduced. The vasodilative effect of Celiprolol probably results in part from its partial agonist properties at the level of the beta-2 receptors. It is devoid of any cardiodepressive effect at the doses used in clinical practice. Discontinuation of therapy Discontinuation of therapy in a patient with coronary artery disease may lead to rebound angina, arrhythmia or myocardial infarction. Diabetes and Hypoglycaemia Beta blockers may mask tachycardia occurring with hypoglycaemia.

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The solution that is produced ents: cetearyl octanoate safe 10 mg prozac, glycerin purchase cheap prozac on line, glyceryl stearate purchase prozac pills in toronto, cet- is stirred into the preemulsion and homogenized. Sodium hydroxide is used to neturalize the car- Benzoic acid is present as a preservative. It has a potency of not less than 6000 polymyxin of bacitracin, a mixture of related cyclic polypeptides B units per milligram, calculated on an anhydrous basis. It has a potency of not less than 40 bacitracin units equal to 10,000 polymyxin B units; inactives: white pet- per milligram. After cooling the oleaginous phase to about 55°C, the triacetin solution is added to the ole- 1. Mixing should be pylene glycol stearate are melted together by of sufficient intensity to disperse the triacetin heating to 75°–85°C, and mixed, thus creating finely and uniformly. Base Ointment Bill of Materials Scale (g/100 g) Item Material Name Quantity/kg (g) 10. After cooling the oleaginous phase to about 45°C, the triacetin is added to the oleaginous phase while mixing. Mixing should be of suf- ficient intensity to disperse the triacetin finely and uniformly. Formulations of Semisolid Drugs 107 Base Ointment Bill of Materials Scale (g/100 g) Item Material Name Quantity/kg (g) 5. To make the oleaginous phase, white petrola- perse the triacetin finely and uniformly. Mixing is continued while cooling the ointment crystalline wax are melted at 75°–85°C. After cooing the oleaginous phase to about 55°C, the triacetin is Base Cream for Extemporaneous Preparations Bill of Materials Scale (g/100 g) Item Material Name Quantity/kg (g) 7. Heat items 7 and 8 until the active ingredient is dissolved, mix with aqueous solution, and 1. Heat a mixture of items 1–5 and the water sep- continue to stir during cooling to room temper- arately to about 80°C. In a suitable vessel, charge liquid paraffin, mixture to cool gradually to room temperature. The gel is a nonsterile, low-bioburden, preserved, let-derived growth factor for topical administration. Each gram of polypeptide chains that are bound together by disulfide gel contains 100 µg of becaplermin. Formulations of Semisolid Drugs 109 Benzalkonium Chloride and Zinc Oxide Cream Bill of Materials Scale (mg/g) Item Material Name Quantity/kg (g) 0. Adjust the turbo-mixer of the steam-jacketed tank containing the aqueous phase to maximum 1. Gen- eted tank with vacuum with high-speed agitator erate as much vacuum as possible, and maintain and an adjustable slow-speed anchor type with it for the rest of the process. If necessary, mill zinc oxide in a Fitz mill or temperature decrease (down to 60°C). Stop similar impact-forward, maximum-speed mill, turbo-mixer and put the anchor-type agitator at fitted with a 250-µm aperture screen. Continue to mix until the perfume is completely zinc oxide in solution of stepabove. Dissolve benzalkonium chloride and glycerin in solution maintain temperature at 75°C. In a separate steam jacketed tank, add Polawax, cetostearyl alcohol, acetylated lanolin, oil-neutral vegetable triglycerides mixture, and propylpa- raben, and carefully melt at 70°C. Benzocaine Cream Bill of Materials Scale (mg/g) Item Material Name Quantity/kg (g) 180. Formulations of Semisolid Drugs 111 Benzoyl Peroxide and Alpha-Bisabolol Gel Bill of Materials Scale (mg/g) Item Material Name Quantity/kg (g) 2. Benzoyl Peroxide Cream Bill of Materials Scale (mg/g) Item Material Name Quantity/1000 Tablets (g) 460. Sift carbomer 940 into vortex in water; when gel, allow 15 minutes of mixing to complete completely dispersed, sift in item 3. Hydrate carbopol and permulen in warm water, water (item 8) and add to the emulsion. Formulations of Semisolid Drugs 113 Benzoyl Peroxide Lotion The cleansing lotions contain benzoyl peroxide 4% and magnesium aluminum silicate, propylene glycol, sodium 8%, respectively, in a lathering vehicle containing purified hydroxide, sodium lauryl sulfoacetate, and sodium octoxy- water, cetyl alcohol, citric acid, dimethyl isosorbide, docu- nol -2 ethane sulfonate. Betamethasone and Cinchocaine Suppositories Bill of Materials Scale (mg/suppository) Item Material Name Quantity/1000 Suppositories (g) 1. Betamethasone and Salicylic Acid Lotion Bill of Materials Scale (g/100 g) Item Material Name Quantity/kg (g) 0. Add 20% of item 7 in a separate vessel and add sel and slowly add item 4 with vigorous mixing; and dissolve item 2 into it. Use item 7 to rinse solve item 1 in a separate vessel and then add all vessels and add rinsings. Formulations of Semisolid Drugs 115 Betamethasone Cream Bill of Materials Scale (mg/g) Item Material Name Quantity/kg (g) 70. Heat items 7 and 8 until the active ingredient is dissolved, mix with above mixture, and con- 1. Heat a mixture of items 1–5 and item 6 sepa- tinue to stir to cool to room temperature. After cooling the oleaginous phase to about 55°C, the tiacetin solution is added while mix- 1. The betamethasone dipropionate and citric acid ing to make a homogenous dispersion. Mixing are dissolved in the triacetin with mixing and should be of sufficient intensity to disperse the heat to 35°C if needed. Mixing is continued while cooling at room tem- stearate, and mineral oil are melted together by perature. Betamethasone Gel Bill of Materials Scale (mg/g) Item Material Name Quantity/kg (g) 1. Prepare the solution of items 1–3 at room tem- perature and solution of items 4 and 5 at about 6°C (or at >70°C). Formulations of Semisolid Drugs 117 Betamethasone Opthalmic Ointment Bill of Materials Scale (g/100 g) Item Material Name Quantity/kg (g) 1. In a separate vessel, dissolve item 1 in 200 mL of water for injection and add to step 1 under 1. Betamethasone Valerate and Cinchocaine Ointment Bill of Materials Scale (mg/g) Item Material Name Quantity/kg (g) 5.